Musculoskeletal conditions of the foot and ankle: assessments and treatment options

Making room for occupational health nursing in Nanda‐I: “Impaired foot health” as a diagnosis

OBJECTIVE

Discuss the label "impaired foot health" to be considered a problem-focused nursing diagnosis according to the taxonomy of NANDA-I.

METHODS

Discussion article based on literature reviews and observational studies based on the authors' PhD ongoing research about foot health among nursing students and professionals.

FINDINGS

Attending to the definition of nursing diagnosis and the scope of nursing practice internationally, several human responses and contexts should be considered, opening new opportunities for NANDA-I completeness.

CONCLUSIONS

A new nursing diagnosis has been disclosed, opening new dimensions to the NANDA-I taxonomy.

IMPLICATIONS FOR NURSING

This nursing diagnosis represents an opening door for the taxonomy, particularly for occupational health nursing in an international context.

Impact of Lymphedema on Foot-Health-Related Quality of Life: A Case-Control Investigation

OBJECTIVE

To evaluate the foot-health-related quality of life in individuals with versus without lower-limb lymphedema.

METHODS

A case-control study was carried out in an academic clinic in Lisbon, Portugal. Eighty participants (40 controls and 40 with lymphedema) were included in the study. The researchers examined sociodemographic and clinical data and foot-health-related quality of life in both groups. In the group with lymphedema, lower-limb lymphedema was also characterized.

RESULTS

Individuals with lower-limb lymphedema had significantly lower scores on all dimensions of the Foot Health Status Questionnaire in comparison with the control group.

CONCLUSIONS

Individuals with lower-limb lymphedema appear to have a poorer foot-health-related quality of life than the general population.

Foot drop in critically ill patients: a narrative review of an elusive complication with intricate implications for recovery and rehabilitation

Foot drop is a condition characterized by the inability to lift the foot upwards towards the shin bone. This condition may affect a proportion of critically ill patients, impacting on their recovery after the acute phase of the illness. The occurrence of foot drop in critical care patients may result from various underlying causes, including neurological injuries, muscular dysfunction, nerve compression, or vascular compromise. Understanding the etiology and assessing the severity of foot drop in these patients is essential for implementing appropriate management strategies and ensuring better patient outcomes. In this comprehensive review, we explore the complexities of foot drop in critically ill patients. We search for the potential risk factors that contribute to its development during critical illness, the impact it has on patients' functional abilities, and the various diagnostic techniques adopted to evaluate its severity. Additionally, we discuss current treatment approaches, rehabilitation strategies, and preventive measures to mitigate the adverse effects of foot drop in the critical care setting. Furthermore, we explore the roles of critical care physical therapists, neurologists, and other healthcare professionals in the comprehensive care of patients with foot drop syndrome and in such highlighting the importance of a multidisciplinary approach.

Ankle Telemedicine Planning Considerations

A virtual medical visit, also known as telemedicine or telehealth, is a valuable alternative method of providing health care to patients who do not have easy access to a hospital, or during times when limited social interaction is crucial such as our current COVID-19 pandemic. A virtual approach to evaluating musculoskeletal system ailments is particularly challenging, for diagnosis of these conditions generally rely greatly on physical examination, which may be challenging. However, a properly planned and executed telemedicine visit will yield successful results in most cases. Our aim is to produce a document with instructions and suggestions, including physical examination maneuvers, to help physicians carry out a proper virtual medical visit with patients complaining of ankle musculoskeletal problems. Virtual visits should not be thought of as a replacement for traditional face-to-face medical consultations, but rather a complementary method to provide health care when deemed appropriate. By following this guide, and tailoring it to the specific case at hand, medical providers should be able to effectively carry out a successful telemedicine consultation for musculoskeletal ailments relating to the ankle.Levels of Evidence: Level V.

＜Editors' Choice＞ The relationship between preoperative foot alignment and postoperative outcomes in patients who underwent initial total knee arthroplasty

We compared the relationship between foot alignments and quality of life in patients who underwent initial total knee arthroplasty (TKA). Among the patients with knee osteoarthritis (KOA) who underwent TKA from May 2015 to May 2017 at our hospital, we focused on those in whom weight-bearing foot radiographs had been evaluated preoperatively. The hallux valgus angle and Meary angle were measured by preoperative radiography, and those with hallux valgus angles of 20 degrees or more were classified into the hallux valgus (HV) group, and those with Meary angles of 4 degrees or more into the high arch (HA) group. Also knee and ankle range of motion, knee pain Visual Analog Scale, and the 36-item short-form health survey (SF-36) were measured preoperatively and at discharge, and the amount of these changes was compared in the presence/absence of HV and HA. Regarding HV, there were no significant differences in any of these items between the HV and non-HV groups. However, the SF-physical function was significantly lower in the HA group than in the normal group. In addition, ankle dorsiflexion was lower in the HA group than that in the normal group, although this difference was not statistically significant. There was little improvement of the ankle dorsiflexion, and it was associated with deterioration of the physical function items of SF-36. In total knee arthroplasty patients with HA, physical therapy of the ankles and feet, as well as of the knees, was considered to enhance the improvement of physical function.

The Classic Three-Month Post-Operative Adaptation Phase in Foot and Ankle Surgery-An Expert Perspective

Foot and ankle disorders are a common reason for orthopedic surgical intervention. After surgery, specific precautions such as partial weight bearing or complete unloading, and the use of walking aids, coupled with a period of rest, are usually implemented to ensure the surgical outcome. However, when these aids are discontinued and the patients resume load increase and normal daily activities, they may enter a transitional phase characterized by inflammation, swelling, and pain. We call this phenomenon the "classic three-month post-operative adaptation phase" (POAP). It is essential to differentiate this physiological transition phase from other conditions, such as from the immediate post-surgical inflammation, complex pain regional syndrome, or an infection. The objective of this expert opinion is to describe and raise medical awareness of this evidence-based phenomenon, which we commonly observe in our daily practice.

Prospective, Long-Term Functional Outcomes of Extra-Osseous Talotarsal Stabilization (EOTTS) Using HyProCure in Adult Patients with Talotarsal Joint Instability: Assessment of Physical Activity and Patient Satisfaction

BACKGROUND

The partial dislocation of the talus from the calcaneus and navicular bones is a primary factor leading to a prolonged overpronation during weightbearing. This study aimed to assess the possibility of returning to physical activity and long-term patient satisfaction after an extra-osseous talotarsal stabilization (EOTTS) procedure with a HyProCure sinus tarsi implant for partial talotarsal joint dislocation (TTJ).

METHODS

A total of 41 adult patients (61 feet), with an average age of 46.41, were included and treated surgically with EOTTS as a stand-alone surgery. Physical activity and functional scores were assessed pre- and post-operatively using questionnaires-the UCLA Activity Score, Symptom-Related Ankle Activity Scale (SAAS), Sports Frequency Score (SFS), Lower Extremity Functional Scale (LEFS), and VAS scale. Satisfaction was assessed on a ten-point scale. The follow-up period was on average 8.61 years (from 7.33 to 10.31).

RESULTS

EOTTS had a positive impact on physical activity, and a high rate of patient satisfaction (8.95 ± 1.9) was noted. The treatment led to a reduction in foot pain, as well as an increase in SAAS and LEFS scores (15,6% and 19,3%, respectively, p <0.01). The VAS pain score decreased by 18,6% (p <0.001). SFS and UCLA scores showed a small increase, but it was not statistically significant. A positive correlation was noted between patient satisfaction and time of physical activity per week (R = 0.33, p =0.04), and also between patient satisfaction and SAAS scores (R = 0.43, p =0.005). Pain from other joints (knee, hip) was eliminated or reduced in 40% of patients after surgery.

CONCLUSIONS

EOTTS with a HyProCure implant is an effective long-term treatment option for partial talotarsal joint dislocation, leading to a reduction in foot pain and increased patient satisfaction, and allowing for a return to physical activity.

The assessment and management of sesamoiditis: a focus group study of podiatrists in Aotearoa New Zealand

BACKGROUND

Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis.

METHODS

This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data.

RESULTS

A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms.

CONCLUSION

Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient's social factors, symptomology, and lower limb biomechanics.

Cross-cultural adaptation and validation of the Arabic version of oxford ankle foot questionnaire for children

PURPOSE

The purpose of this study was to translate and cross-culturally adapt the original English version of the Oxford Ankle Foot Questionnaire (OxAFQ-c) into the Arabic language, and to evaluate its psychometric properties among Arabic speaking children aged from 5 to 16 years in Saudi Arabia.

MATERIALS AND METHODS

An Arabic OxAFQ-c for children was developed according to established guidelines (ISPOR). The Arabic OxAFQ-c version was completed by eighty-seven patients with foot and ankle problems and their caregivers. Construct validity of the Arabic OxAFQ-c was also examined.

RESULTS

The reliability analysis of OxAFQ-Ar exhibited good internal consistency in both children's and parent's versions for all domains (α = 0.80-0.89) and excellent test-retest reliability in both versions for all domains. (ICC = 0.87-0.94). A moderate correlation between the OxAFQ-Ar and PedsQL 4.0 was observed indicating moderate construct validity.

CONCLUSIONS

The OxAFQ-c was successfully translated and cross-cultural adapted into the Arabic language. The OxAFQ-Ar is a valid, reliable and useful quality of life questionnaire for evaluating children's ankle foot problems.IMPLICATION OF REHABILITATION OF OxAFQ-c ARABIC VERSIONThe Arabic version of the OxAFQ-c is an acceptable, clear and comprehensible outcome measure.The Arabic version of the OxAFQ-c demonstrated evidence supporting its internal consistency, test-retest reliability and construct validity as a measure to evaluate foot and ankle pathologies in patients aged 5-16 years.The Arabic OxAFQ-c has very good internal consistency, test-retest reliability, and acceptable measurement error with no floor and ceiling effects.The Arabic version of the OxAFQ-c can be used in daily clinical practice and in research studies to assess children aged from 5 to 16 years in Arabic speakers with ankle-foot conditions.

Development and Effectiveness Testing of a Novel 3D-Printed Multi-Material Orthosis in Nurses with Plantar Foot Pain

Plantar foot pain is one of the most common musculoskeletal conditions affecting the foot. It is regularly experienced by the population with occupations that require prolonged standing hours, especially in nurses. The etiology of plantar foot pain remains unclear, but it is likely to be multi-factorial, with many associated risk factors including increased hours of standing. Orthoses and insoles are often recommended to plantar foot pain patients, however with minimal scientific advancements and limited customizations. In this study, a novel 3D-printed multi-material customized foot orthosis was developed, and its effectiveness on plantar foot pain reduction and functional ability improvement was studied in the nursing population. A total of thirty-six subjects were recruited and were randomized into two groups. The experimental group received the novel 3D-printed multi-material customized foot orthosis, whereas the control group received the standard-of-care (or traditional) intervention. Pre-test and the post-test scores of pains, functional ability and plantar pressure were observed using SPSS software. Improvements were observed in both of the groups; however, better improvements were seen in the experimental group. Overall, the novel 3D printing-based customized foot orthosis showed significant efficacy in reducing plantar foot pain and pressure, and also in increasing functional ability in the nursing population as compared to the traditional method.

Swefoot - The Swedish national quality register for foot and ankle surgery

BACKGROUND

Population-based register data could be used to improve our knowledge of patients surgically treated for foot and ankle disorders. The quality register Swefoot was recently created to collect surgical and patient-reported data of foot and ankle surgery. This manuscript aims to describe the development and current use of the register.

METHODS

The development of Swefoot started in 2014 and currently, data on 16 different diagnoses are collected in 49 units performing foot and ankle surgery. Registrations are performed by the surgeon and the patient.

RESULTS

Between 2014 and 2020 approximately 20,000 surgical procedures have been registered. 75.1% of the registered patients were women, 9.3% were smokers, 9.3% had a concomitant rheumatoid disease, and 18.4% a BMI larger than 30 kg/m²_. CONCLUSIONS: The Swefoot is a unique national register for foot and ankle surgery. It is by now possible to present demographic, surgical, and outcome parameters based on Swefoot.

The Importance of Foot Function Assessment Using the Foot Function Index-Revised Short Form (FFI-RS) Questionnaire in the Comprehensive Treatment of Patients with Rheumatoid Arthritis

BACKGROUND

Foot problems may have a substantial negative impact on rheumatoid arthritis (RA) patients' mobility. They affect walking and the functional capacity to perform daily tasks.

METHODS

This study included 61 patients with RA and foot pain or swelling. The study group comprised 37 patients (aged 54.3 ± 9.5 years) with foot lesions, as demonstrated in an ultrasound, and the control group comprised 24 patients (aged 57.3 ± 11.5 years) without foot lesions. The patients' health statuses were evaluated with the Foot Function Index-Revised Short Form (FFI-RS), the Polish version of the Health Assessment Questionnaire-Disability Index (HAQ-DI), and the Disease Activity Score 28 (DAS 28).

RESULTS

The FFI-RS showed significant differences between the study and control groups in total results, as well as in the pain and stiffness subscales. Subsequent analyses showed numerous significant correlations. The FFI-RS total results correlated with the HAQ's standing up, walking, and total results. The FFI-RS pain results correlated with the social issues and HAQ's total results. The FFI-RS difficulty results correlated with the disease's duration. In the study group, there were significant correlations of the FFI-RS stiffness, difficulty, and social issues results with the HAQ's standing up, walking, and total results, and also of the FFI-RS activity limitation results with the HAQ's standing up results. In the control group, there were correlations of the FFI-RS stiffness, difficulty, and activity limitation results with the HAQ's walking and total results. Finally, in the study group, we also found correlations of the FFI-RS total, pain, stiffness, difficulty, and social issues results with the Visual Analog Scale (VAS) results, as well as of the FFI-RS total results with the DAS 28 results.

CONCLUSIONS

The FFI-RS is an effective tool for assessing RA patients' functional status and can be used to evaluate treatment effects. The FFI-RS detected RA-related changes in the foot joint function in patients without foot lesions, as assessed by ultrasound.

The influence of myofascial release on pain and selected indicators of flat foot in adults: a controlled randomized trial

Flat foot pain is a common complaint that requires therapeutic intervention. Currently, myofascial release techniques are often used in the therapy of musculoskeletal disorders. A group of 60 people suffering from flat feet with associated pain. Patients were assigned to four groups (15 people each): MF-myofascial release, E-the exercise program, MFE-myofascial release and the exercise program, C-no intervention. The rehabilitation program lasted 4 weeks. The NRS scale was used to examine pain intensity and FreeMed ground reaction force platform was used to examine selected static and dynamic foot indicators. Statistically significant pain reduction was obtained in all research. A static test of foot load distribution produced statistically significant changes only for selected indicators. In the dynamic test, statistically significant changes were observed for selected indicators, only in the groups subjected to therapeutic intervention. Most such changes were observed in the MF group. In the dynamic test which assessed the support phase of the foot, statistically significant changes were observed only for selected subphases. Most such changes were observed in the MFE group. Both exercise and exercise combined with myofascial release techniques, and especially myofascial release techniques alone, significantly reduce pain in a flat foot. This study shows a limited influence of both exercises and myofascial release techniques on selected static and dynamic indicators of a flat foot.

Effects of human variation on foot and ankle pain in rural Madagascar

OBJECTIVES

Foot and ankle dysfunction in barefoot/minimally shod populations remains understudied. Although factors affecting musculoskeletal pain in Western populations are well-studied, little is known about how types of work, gender, and body shape influence bone and joint health in non-Western and minimally shod communities. This study examines the effect of human variation on locomotor disability in an agrarian community in Madagascar.

MATERIALS AND METHODS

Foot measurements were collected along with height, weight, age, and self-report data on daily activity and foot and ankle pain from 41 male and 48 female adults. A short form revised foot function index (FFI-R), that measures functional disability related to foot pain, was calculated. Raw and normalized foot measurements were compared by gender and used in a multiple linear regression model to determine predictors of FFI-R.

RESULTS

Compared to men, women reported higher FFI-R scores (p = 0.014), spent more time on their feet (p = 0.019), and had higher BMIs (p = 0.0001). For their weight, women had significantly smaller and narrower feet than men. Bimalleolar breadth (p = 0.0005) and foot length (p = 0.0223) standardized by height, time spent on feet (p = 0.0102), ankle circumference standardized by weight (p = 0.0316), and age (p = 0.0090) were significant predictors of FFI-R score.

DISCUSSION

Our findings suggest that human variation in anatomical and behavioral patterns serve as significant explanations for increased foot and ankle pain in women in this non-Western rural population. Foot and ankle pain were prevalent at similar levels to those in industrialized populations, indicating that research should continue to examine its effect on similar barefoot/minimally shod communities.

Hip-Focused Neuromuscular Exercise Provides Immediate Benefits in Foot Pronation and Dynamic Balance: A Sham-Controlled Cross-Over Study

CONTEXT

Knowledge on how to utilize a kinetic chain approach in foot and ankle rehabilitation is important.

OBJECTIVE

The aim of this study was to investigate the immediate effects of hip-focused neuromuscular exercise on foot pronation and single-leg neuromuscular control.

DESIGN

Cross-over study.

SETTING

University laboratory.

PARTICIPANTS

This cross-over study included 44 asymptomatic volunteers with foot pronation.

INTERVENTIONS

All participants performed (1) a hip-focused neuromuscular exercise and (2) a sham exercise in randomized order.

MAIN OUTCOME MEASURES

Foot pronation was assessed by the navicular drop test, and lower-extremity neuromuscular control was assessed by the Modified Star Excursion Balance Test and frontal plane projection angle during single-leg squat before and after the experiments.

RESULTS

Navicular drop test scores were significantly lower after the hip-focused neuromuscular exercise than after the sham exercise (mean difference [95% CI] = 2.84 [-1.08 to 6.77], P = .003). Modified Star Excursion Balance Test scores in the anterior (P = .008), posteromedial (P = .04), and posterolateral (P < .001) directions were significantly increased after hip-focused neuromuscular exercise. No statistically significant condition × time interaction was found for the frontal plane projection angle (P > .05). However, a main effect of time (P = .003) indicated that less dynamic knee valgus occurred during single-leg squat after both experiments.

CONCLUSIONS

Hip-focused neuromuscular exercise produced immediate alterations in foot pronation and dynamic balance. Thus, the hip-focused neuromuscular exercise may be used to control foot posture in foot rehabilitation integrated with a kinetic chain approach and could be an effective prevention and treatment strategy.

Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis

Introduction

Patients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively affects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear.

Objective

To evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infiltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction.

Methods

We performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confirmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient’s baseline status. The pre-post differences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann–Whitney test.

Results

Using our protocol, we recorded a rapid and significant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with significant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear.

Conclusions

Our multidisciplinary therapeutic protocol enabled a very significant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary.

Key Points • Multidisciplinary evaluation of patients with RA is advisable because it improves the treatment management in cases of inflammatory activity and structural abnormalities of the foot. • Comprising orthopedic-podiatric treatment (heel, splints, and suitable footwear) and infiltrations, in terms of clinical, ultrasound, and functional recovery of the foot tendons. • The therapy protocol we propose led to a significant improvement in pain relief and functional recovery.

A conceptual framework for contemporary professional foot care practice: ''The value based digital foot care framework''

BACKGROUND

A small minority of countries around the globe have podiatry as a recognized profession, hence, there are considerable differences among these countries when it comes to the curricula, the duration of training and legislation regulating the profession. The growth in research led evidence based practice, and the emerging digital landscape of health care practice, occur alongside trends in disease and health behaviours that strongly impact on foot health. As such, the changing complex role of the podiatrist requires critical reflection on current frameworks of practice and whether they are fit for purpose. This commentary presents a conceptual framework which sets the scene for further development of concepts in a podiatry context, reflecting contemporary health care beliefs and the changing expectations of health care and society. The proposed conceptual framework for podiatry practice utilizes the metaphor of an electronic circuit to reflect the vast and complex interconnections between factors that affect practice and professional behaviours. The framework helps in portraying and defining drivers of practice, actual practice as well potential barriers for current and future practice. The circuit emphasis the interconnectedness/interaction of three clusters: 1) internal factors, 2) interaction factors, 3) external factors.

CONCLUSION

Whatever promise this new framework holds, it will only be realised through conscious development of community consensus, respectful dialogue, constructive critical appraisal, and maintaining passion and focus on improving the health of people with foot related problems.

Electromyographic Activity of Hip Musculature During Functional Exercises in Participants With and Without Chronic Ankle Instability

Objective

The main objective of the present study was to investigate the electromyographic (EMG) activity of gluteus medius (Gmed) and gluteus maximus (Gmax) muscles during functional exercises in subjects with chronic ankle instability (CAI) vs healthy controls.

Methods

Seventeen subjects (age, 24.4 ± 2.03 years) with CAI and 17 healthy controls (age, 24.6 ± 2.57 years) were recruited for the present study. For all participants, after testing maximum voluntary isometric contraction of the Gmed and Gmax muscle, EMG activity of these muscles was recorded during functional exercises, such as the Y Balance Test and the single-leg squat with and without Swiss ball.

Results

EMG activity of Gmed and Gmax was found to be significantly (P < .05) reduced during all functional exercises in subjects with CAI when compared with healthy controls. No significant differences (P > .05) were observed in the EMG activity of both muscles across different functional exercises.

Conclusion

Our findings indicate that EMG activity of hip muscles is significantly reduced in CAI subjects, which might give an indication regarding the inclusion of hip muscle strengthening (Gmax and Gmed) in the rehabilitation of CAI. Moreover, Gmed and Gmax muscle activity did not vary during the different functional exercises within each group, which might indicate that activation pattern of these muscles are not sensitive to the type of functional task.

Comparison of Patient-Reported Outcomes for Major Pathologies of the Forefoot, Midfoot, Hindfoot, and Achilles Using PROMIS

Background:

Patient-Reported Outcomes Measurement Information System (PROMIS) is a newly developed patient-reported outcome that has been validated for the general foot and ankle population and has been applied to a variety of specific foot and ankle procedures. However, there is little data regarding clinical outcomes of patients at a more intermediate subgroup level. Thus, our study utilized PROMIS to provide normative data on pathologic conditions of the foot and ankle and assess postoperative outcomes based on anatomical location.

Methods:

Preoperative and 1-year postoperative PROMIS Physical Function (PF) and Pain Interference (PI) surveys were prospectively collected from a cohort of patients undergoing a foot and ankle procedure at a tertiary medical center. The cohort was split into forefoot (n = 136), midfoot (n = 44), hindfoot (n = 109), and Achilles (n = 62) procedure groups. Paired-t tests were used to compare preoperative versus postoperative outcomes within operative groups, while a 1-way analysis of variance (ANOVA) was used to detect differences in PROMIS scores between anatomic subgroups.

Results:

Paired t tests indicated that all 4 operative groups had significantly improved PROMIS PF and PI scores preoperatively versus 1 year postoperatively (all P < .001). One-way ANOVA demonstrated that there were no differences in postoperative PROMIS PF and PI scores between anatomic subgroups. A majority of patients achieved the minimal clinically important difference level of improvement in PROMIS PF and PI scores following surgery.

Conclusions:

All 4 operative groups had improvement in physical function and pain outcomes. Additionally, there were no differences in physical function and pain outcomes between operative groups.

Level of Evidence:

Level III, retrospective cohort study.

Identification of patterns of foot and ankle pain in the community: Cross-sectional findings from the clinical assessment study of the foot

OBJECTIVES

To investigate patterns of foot and ankle pain locations and symptoms, socio-demographic and comorbid characteristics to examine whether there are distinct foot and ankle pain phenotypes.

METHODS

Adults aged ≥50 years registered with four general practices in North Staffordshire were mailed a Health Survey questionnaire. Participants reporting foot pain in the last month indicated foot pain location on a foot manikin. Foot and ankle pain patterns were investigated by latent class analysis. Associations between the classes with foot pain symptoms, socio-demographic and comorbid characteristics were assessed.

RESULTS

Four thousand four hundred fifty-five participants with complete foot pain and manikin data were included in this analysis (mean age 65 years [SD 9.8], 49% male). Of those with foot and ankle pain (n = 1356), 90% had pain in more than one region. Six distinct classes of foot and ankle pain were identified: no pain (71%), bilateral forefoot/midfoot pain (4%), bilateral hindfoot pain (5%), left forefoot/midfoot pain (8%), right forefoot/midfoot pain (5%) and bilateral widespread foot and ankle pain (6%). People with bilateral widespread foot and ankle pain were more likely to be female, obese, depressed, anxious, have/had a manual occupation, have comorbidities, lower SF-12 scores and greater foot-specific disability. Age did not differ between classes.

CONCLUSIONS

Six distinct classes of foot and ankle pain locations were identified, and those with bilateral widespread foot and ankle pain had distinct characteristics. Further investigation of these individuals is required to determine if they have poorer outcomes over time and whether they would benefit from earlier identification and treatment.

Feasibility Study of a Rapid Evaluate and Adjust Device (READ) for Custom Foot Orthoses Prescription

OBJECTIVE

Custom foot orthoses (CFOs) are typically used for the prevention and cure of lower extremity injuries (LEIs). Typically, CFOs are designed and prescribed based on iterative loops including: (1) follow-up loops between the patient and the physician, and (2) design feedback loops between the physician and the fabricator. The current prescription methodology has some deficiencies, i.e. excessive time to satisfactory treatment, and low repeatability in custom fabrication because of missing alignment, soft tissue considerations, and subjective feedback. There are significant opportunities to develop a new CFOs prescription procedure which can improve accuracy prior to the fabrication process by reducing time through minimizing iterations.

METHODS

First, a novel "rapid evaluate and adjust device" (READ) prescription methodology is proposed for CFO design by combining the follow-up loops with design feedback loop. To support the idea of the READ prescription method a novel 3D ergonomic measurement system (3DEMS) is developed. The 3DEMS is designed for the following key targets to: (1) improve the communication between the patient/physician and the fabricator, (2) reduce time to satisfactory treatment, (3) improve repeatability by considering the alignment and the soft tissue deformations, (4) archive digitally with minimal data, (5) reduce the system complexity, and (6) validate with plantar pressure measurements (i.e. Novel Pedar^®). The design process of the 3DEMS involved the following steps: (1) 3D data collection at the desired loading, (2) nested optimization to determine optimal segment design, and (3) system fabrication considering alignment and feedback control.

RESULTS

The results show that the READ prescription method with 3DEMS can be used to recreate the medial longitudinal arch for a range of arch height indices (AHI) by using a minimal number of parameters i.e. 6 parameters, and significant increases in mean peak pressure are observed between optimized and barefoot or flat segments.

CONCLUSION

This study establishes that the proposed READ prescription method with the 3DEMS may be used for CFOs prescription due to better communication between individuals in the follow-up and design loops, less time for satisfactory treatment, improved repeatability, archivable data, and low system complexity.

SIGNIFICANCE

The developed system may be used as measurement systems for CFOs, and in the future the proposed 3DEMS may prove highly important for the measurement of CFOs for flat feet.

The effect of a 12-week custom foot orthotic intervention on muscle size and muscle activity of the intrinsic foot muscle of young adults during gait termination

BACKGROUND

The tissue stress theory is commonly used to prescribe foot orthoses, however the mechanisms of foot orthoses are not understood well. The effect foot orthotics have on the plantar intrinsic muscles remains unclear. The study was designed to assess changes in muscle size and activity of the intrinsic muscles of individuals with pes planus after wearing custom-made foot orthotics for 12-weeks.

METHODS

Eighteen young adults with pes planus were allocated by stratified sampling into the orthotic group (n = 9) or control group (n = 9). Ultrasonography measured the cross-sectional area of the flexor digitorum brevis, abductor digiti minimi, and abductor hallucis at baseline, 6 and 12-weeks. Subsequently, participants completed an unexpected gait termination protocol (12 of 50 trials unexpected) and average electromyography magnitude was recorded.

FINDINGS

After 12-weeks the orthotic group cross-sectional area significantly decreased by 9.6% (P < .001) for the flexor digitorum brevis, 17.1% for abductor digiti minimi (P < .001) and 17.4% for abductor hallucis (P < .001). There were no significant differences of muscle activity magnitude for the intrinsic muscles.

INTERPRETATION

The short-term use of custom-made foot orthoses created a decrease in muscle size of the flexor digitorium brevis, abductor digiti minimi and abductor hallucis plantar intrinsic muscles but had no effect on muscle activity. Clinically, these results help to understand the adaptations that are created when foot orthoses are supporting a pes planus foot structure when reducing plantar pressures. These findings may help enhance the prescription of foot orthoses by adding a strength program to prevent disuse atrophy of these muscles.

Assessment of the structural validity of three foot and ankle specific patient-reported outcome measures

BACKGROUND

The structural validity of the Lower extremity functional scale (LEFS), the Visual analogue scale foot and ankle (VAS-FA), and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) has not been compared earlier in patients after foot and ankle surgery.

METHODS

Altogether 165 previously operated patients completed the foot and ankle specific instruments, the 15D health-related quality of life (HRQoL) instrument, and general health (VAS).

RESULTS

The LEFS, the VAS-FA and the WOMAC had slight differences in their measurement properties. The VAS-FA had the best targeting and coverage. All three foot and ankle measures accounted for mobility and usual activities when compared to the different aspects of generic HRQoL.

CONCLUSIONS

The LEFS, the VAS-FA and the WOMAC have relatively similar psychometric properties among foot and ankle patients, yet the VAS-FA provides the best targeting and coverage.

The center of pressure progression characterizes the dynamic function of high-arched feet during walking

Background

The medial longitudinal arch height has an effect on kinetic parameters during gait and might be related to the risk of injury. For the assessment of foot structures, the center of pressure (COP) trajectory is a more reliable and practical parameter than plantar pressure. This study aimed to clarify the COP trajectory and velocity characteristics in the medial-lateral and anterior-posterior direction of individuals with a high-arched foot during barefoot walking.

Methods

Sixty-two healthy young adults were asked to walk over a Footscan pressure plate to record the COP parameters during the stance phase of walking.

Results

Compared to normal arched feet, the COP during forefoot contact and foot flat phases of high-arched feet shifted anteriorly (19.9 mm and 15.1 mm, respectively), and the mean velocity of COP in anterior-posterior direction decreased by 0.26 m/s and increased by 0.044 m/s during these two phases respectively.

Conclusions

The findings of this study suggest that the displacement and velocity of COP in anterior-posterior direction was different between high-arched and normal-arched subjects during barefoot walking, which can be used for the assessment of gait characteristics for high-arched individuals. The results of this study may provide insights into modifying clinical intervention for individuals with high-arched feet to enhance rehabilitation and prevent injuries and have implications for assessing the design of footwear and foot orthotics.

Graphical abstract

Baropodometric evaluation of foot load distribution during gait in the group of professionally active nurses

OBJECTIVES

Nurses are extremely exposed to musculoskeletal overloads. Prolonged standing postural balance distributions, functional deficits and pain may affect the symmetry of the load on the feet. The study aimed to assess the distribution of foot load during gait among nurses.

METHODS

The sample of this prospective and observational study consisted of 37 female nurses with mean age of 39 years. The Nordic Musculoskeletal Questionnaire (NMQ) was used to evaluate musculoskeletal disturbances and baropodometric gait analysis (BGA) was performed to register distribution of foot load during gait.

RESULTS

We showed that 68% of nurses declare that they know the principles of workplace ergonomics, but only 14% comply with them. NMQ results indicate that as many as 73% of the respondents feel ailments in the "lower back" area. An asymmetry was observed in the load of IV-V of the metatarsal head between the left and right foot (P = .000) and in the load of the left and right lateral part of the heel (P = .028) in the BGA test. Correlations between ailments occurring in the neck area and loading of the lateral arch of the right foot (P = .032) were found. Moreover, the load in this area correlated positively with the occurrence of "lower back" pain (P = .045).

CONCLUSIONS

Nurses have asymmetric distribution of foot load during gait, which results in a discrepancy between the loads on the three main support points of the foot and which may affect nurses' work productivity.

Concurrent Validity of the Foot Health Status Questionnaire and Study Short Form 36 for Measuring the Health-Related Quality of Life in Patients with Foot Problems

Background and Objectives: Foot problems may be considered to be a prevalent condition and impact the health-related quality of life (QoL). Considering these Spanish-validated tools, the Foot Health Status questionnaire (FHSQ) may provide a health-related QoL measurement for specific foot conditions and general status. To date, the domains of the FHSQ and Medical Outcomes Study Short Form 36 (SF-36) have not been correlated. Therefore, the main aim of this study was to correlate the domains of the FHSQ and SF-36 in patients with foot problems. Materials and Methods: A cross-sectional descriptive study was carried out. A sample of 101 patients with foot problems was recruited. A single researcher collected descriptive data, and outcome measurements (FHSQ and SF-36) were self-reported. Results: Spearman's correlation coefficients (r_s) were calculated and categorized as weak (r_s = 0.00-0.40), moderate (r_s = 0.41-0.69), or strong (r_s = 0.70-1.00). In all analyses, statistical significance was considered with a p-value < 0.01 with a 99% confidence interval. Statistically significant differences (p < 0.01) were found between all domains of FHSQ and SF-36, except for the mental health domain of the SF-36 with foot pain, foot function, and general foot health of the FHSQ, as well as between the vitality domain of the SF-36 and the general foot health domain of the FHSQ (p > 0.01). Statistically significant correlations varied from week to strong (r_s = 0.25-0.97). The strongest correlations (p < 0.001) were found for physical activity and physical function (r_s = 0.94), vigor and vitality (r_s = 0.89), social capacity and social function (r_s = 0.97), and general health domains of the SF-36 and FHSQ. Conclusions: The FHSQ and SF-36 showed an adequate concurrent validity, especially for the physical activity or function, vigor or vitality, social capacity or function, and general health domains. Nevertheless, the mental health domain of the SF-36 should be considered with caution.

Cartilage Stiffness Effect on Foot Biomechanics of Chinese Bound Foot: A Finite Element Analysis

The purpose of this study is to investigate the effect of cartilage stiffness on inner foot biomechanics of Chinese bound foot while balanced standing using finite element method. A three-dimensional FE model of bound foot involving 28 bones, 72 ligaments, 5 plantar fascia, cartilages, and encapsulated soft tissue was constructed and validated. To conduct the sensitivity analysis of cartilage stiffness, the incremental Young’s modulus of 1, 5, 10, and 15 MPa were assigned to the cartilage. 25% of the body weight was applied to the Achilles tendon to adjust the anterior- posterior displacement of center of pressure agreeable with the measured result. As the Young’s modulus of cartilage increased, the peak von Mises stress in the fifth metatarsal increased obviously, while that in the calcaneus remains unchanged. The plantar fascia experienced reduced total tension with stiffer cartilage. The cartilage stiffening also caused a general increase of contact pressure at mid- and forefoot joints. Cartilage stiffening due to foot binding gave rise to risks of foot pain and longitude arch damage. Knowledge of this study contributes to the understanding of bound foot biomechanical behavior and demonstrating the mechanism of long-term injury and function damage in terms of weight-bearing due to foot binding.

Independent factors associated with wearing different types of outdoor footwear in a representative inpatient population: a cross-sectional study

Background

Footwear can have both a positive and negative impact on lower limb health and mobility across the lifespan, influencing the risk of foot pain, ulceration, and falls in those at risk. Choice of footwear can be influenced by disease as well as sociocultural factors, yet few studies have investigated the types of footwear people wear and the profiles of those who wear them. The aim of this study was to investigate the prevalence and factors associated with outdoor footwear type worn most often in a representative inpatient population.

Methods

This study was a secondary data analysis of a cohort of 733 inpatients that is highly representative of developed nations’ hospitalised populations; 62 ± 19 years, 55.8% male, and 23.5% diabetes. Socio-demographic, medical history, peripheral arterial disease, peripheral neuropathy, foot deformity, foot ulcer history, amputation history and past foot treatment variables were collected. Participants selected the footwear type they mostly wore outside the house in the previous year from 16 types of footwear. Multivariate logistic regression identified independent factors associated with outdoor footwear types selected.

Results

The most common outdoor footwear types were: running shoes (20%), thongs/flip flops (14%), walking shoes (14%), sandals (13%) and boots (11%). Several socio-demographic, medical history and foot-related factors were independently associated (Odds Ratio; 95% Confidence Interval)) with different types of footwear. Running shoes were associated with male sex (2.7; 1.8–4.1); thongs with younger age (0.95 for each year; 0.94–0.97), being female (2.0; 1.2–3.1) and socio-economic status (3.1; 1.2–7.6); walking shoes with arthritis (1.9; 1.2–3.0); sandals with female sex (3.8; 2.3–6.2); boots with male sex (9.7; 4.3–21.6) and inner regional (2.6; 1.3–5.1) and remote (3.4; 1.2–9.5) residence (all, p < 0.05).

Conclusions

We profiled the types of outdoor footwear worn most in a large diverse inpatient population and the factors associated with wearing them. Sex was the most consistent factor associated with outdoor footwear type. Females were more likely to wear thongs and sandals and males boots and running shoes. Overall, this data gives insights into the socio-demographic, medical and other health factors that are related to footwear choice in a large diverse population primarily of older age.

Electronic supplementary material

The online version of this article (10.1186/s13047-018-0260-7) contains supplementary material, which is available to authorized users.

Shoe-Insole Technology for Injury Prevention in Walking

Impaired walking increases injury risk during locomotion, including falls-related acute injuries and overuse damage to lower limb joints. Gait impairments seriously restrict voluntary, habitual engagement in injury prevention activities, such as recreational walking and exercise. There is, therefore, an urgent need for technology-based interventions for gait disorders that are cost effective, willingly taken-up, and provide immediate positive effects on walking. Gait control using shoe-insoles has potential as an effective population-based intervention, and new sensor technologies will enhance the effectiveness of these devices. Shoe-insole modifications include: (i) ankle joint support for falls prevention; (ii) shock absorption by utilising lower-resilience materials at the heel; (iii) improving reaction speed by stimulating cutaneous receptors; and (iv) preserving dynamic balance via foot centre of pressure control. Using sensor technology, such as in-shoe pressure measurement and motion capture systems, gait can be precisely monitored, allowing us to visualise how shoe-insoles change walking patterns. In addition, in-shoe systems, such as pressure monitoring and inertial sensors, can be incorporated into the insole to monitor gait in real-time. Inertial sensors coupled with in-shoe foot pressure sensors and global positioning systems (GPS) could be used to monitor spatiotemporal parameters in real-time. Real-time, online data management will enable &lsquo;big-data&rsquo; applications to everyday gait control characteristics.

The regenerative therapies of the ankle degeneration: a focus on multipotential mesenchymal stromal cells

The ankle degeneration ranging from focal osteochondral lesions to osteoarthritis can cause a total joint function loss. With rising life expectancy and activity of the patients, various regenerative therapies were introduced aiming to preserve the joint function via the induction of cartilage and bone repair. Here, biological events and mechanical changes of the ankle degeneration were discussed. The regenerative therapies were reviewed versus the standard surgical treatment. We especially focused on the use of mesenchymal (multipotential) stromal cells (MSCs) highlighting their dual functions of regeneration and cell modulation with an emphasis on the emerging MSC-based clinical studies. Being at an early step, more basic and clinical research is needed to optimize the applications of all ankle regenerative therapies including MSC-based methods.

Identification of Clusters of Foot Pain Location in a Community Sample

OBJECTIVE

To identify foot pain clusters according to pain location in a community-based sample of the general population.

METHODS

This study analyzed data from the North West Adelaide Health Study. Data were obtained between 2004 and 2006, using computer-assisted telephone interviewing, clinical assessment, and self-completed questionnaire. The location of foot pain was assessed using a diagram during the clinical assessment. Hierarchical cluster analysis was undertaken to identify foot pain location clusters, which were then compared in relation to demographics, comorbidities, and podiatry services utilization.

RESULTS

There were 558 participants with foot pain (mean age 54.4 years, 57.5% female). Five clusters were identified: 1 with predominantly arch and ball pain (26.8%), 1 with rearfoot pain (20.9%), 1 with heel pain (13.3%), and 2 with predominantly forefoot, toe, and nail pain (28.3% and 10.7%). Each cluster was distinct in age, sex, and comorbidity profile. Of the two clusters with predominantly forefoot, toe, and nail pain, one of them had a higher proportion of men and those classified as obese, had diabetes mellitus, and used podiatry services (30%), while the other was comprised of a higher proportion of women who were overweight and reported less use of podiatry services (17.5%).

CONCLUSION

Five clusters of foot pain according to pain location were identified, all with distinct age, sex, and comorbidity profiles. These findings may assist in the identification of individuals at risk for developing foot pain and in the development of targeted preventive strategies and treatments.

Predictors of foot pain in the community: the North West Adelaide health study

BACKGROUND

Foot pain has been shown to be prevalent across all age groups. The presence of foot pain may reduce mobility and impact on the ability to undertake activities of daily living. The aim of this study was to determine factors that are predictive of foot pain in a community based sample of the general population.

METHODS

This study analysed data from the North West Adelaide Health Study, a cohort study located in the northwestern suburbs of Adelaide, South Australia. Data were obtained between 2004-2006 and 2008-2010, using a self-completed questionnaire, computer assisted telephone interviewing, and a clinical assessment. The sensitivity, specificity and positive predictive values of variables were determined and generalised linear models ascertained the variables associated with the highest relative risk of self-reporting foot pain in 2008-2010 based on the data obtained in 2004-2006.

RESULTS

The prevalence of foot pain in 2004-2006 was 14.9 % (95 % CI 13.6-16.4) and in 2008-2010, 29.9 % (95 % CI 27.5-32.5). Variables with the highest sensitivity were: female sex, ever having back pain, self-reported arthritis, body mass index (BMI) classified as obese and having foot pain in 2004-2006, while most variables demonstrated high specificity. Those with the highest risk of reporting foot pain in 2008-2010 were those with depressive symptoms, self-reported arthritis, high BMI, self-reported upper limb pain and foot pain (in general or in specific regions of the foot) in 2004-2006.

CONCLUSION

Foot pain is common in the general population and those with the greatest risk of foot pain potentially represent a high level of chronicity and potential burden on the health system. Addressing the factors that predict foot pain, as well as the provision of targeted messages to highlight the importance of managing foot pain, may help reduce the impact on the population.

A Comparison of Fourth-Year Health Sciences Students' Knowledge of Gross Lower and Upper Limb Anatomy: A Cross-Sectional Study

OBJECTIVE

The aim of the study was to assess and compare the knowledge of fourth-year medicine, physiotherapy (PT), nursing, and podiatry students in carpal and tarsal bone anatomy.

METHODS

A cross-sectional study was carried out. Based on a nonprobability convenience sampling, 177 fourth-year students (117 women and 60 men, mean age of 23.16 ± 3.82 years) from the podiatry (n = 39), nursing (n = 26), PT (n = 73), and medicine (n = 39) schools at a large Spanish university were included. Measurements were taken of their gross anatomy knowledge by means of the carpal and the tarsal bone tests. Students were asked to identify all carpal and tarsal bones in an illustration of the bony skeleton of both regions and were given a maximum of 5 minutes per test.

RESULTS

Of a total of 15 bones to be labeled, the PT (11.07 ± 3.30) and podiatry (9.36 ± 2.93) students had the highest rate of correct answers compared with the medicine (6.13 ± 3.27) and nursing (4.04 ± 3.72) undergraduates. When assessing academic degrees and test scores, significant differences were observed between PT and podiatry participants vs those from the medicine and nursing schools (P < .001).

CONCLUSION

Fourth-year students from the PT and podiatry programs correctly identified a higher number of carpal and tarsal bones than students from the nursing and medicine schools.

Impacting clinical evaluation of anterior talofibular ligament injuries through analysis of ultrasound images

Background

Anterior talofibular ligament (ATFL) is considered as the weakest ankle ligament that is most prone to injuries. Ultrasound imaging with its portable, non-invasive and non-ionizing radiation nature is increasingly being used for ATFL diagnosis. However, diagnosis of ATFL injuries requires its segmentation from ultrasound images that is a challenging task due to the existence of homogeneous intensity regions, homogeneous textures and low contrast regions in ultrasound images. To address these issues, this research has developed an efficient ATFL segmentation framework that would contribute to accurate and efficient diagnosis of ATFL injuries for clinical evaluation.

Methods

The developed framework comprises of five computational steps to segment the ATFL ligament region. Initially, region of interest is selected from the original image, which is followed by the adaptive histogram equalization to enhance the contrast level of the ultrasound image. The enhanced contrast image is further optimized by the particle swarm optimization algorithm. Thereafter, the optimized image is processed by the Chan–Vese method to extract the ATFL region through curve evolution; then the resultant image smoothed by morphological operation. The algorithm is tested on 25 subjects’ datasets and the corresponding performance metrics are evaluated to demonstrate its clinical applicability.

Results

The performance of the developed framework is evaluated based on various measurement metrics. It was found that estimated computational performance of the developed framework is 12 times faster than existing Chan–Vese method. Furthermore, the developed framework yielded the average sensitivity of 98.3 %, specificity of 96.6 % and accuracy of 96.8 % as compared to the manual segmentation. In addition, the obtained distance using Hausdorff is 14.2 pixels and similarity index by Jaccard is 91 %, which are indicating the enhanced performance whilst segmented area of ATFL region obtained from five normal (average Pixels—16,345.09), five tear (average Pixels—14,940.96) and five thickened (average Pixels—12,179.20) subjects’ datasets show good performance of developed framework to be used in clinical practices.

Conclusions

On the basis of obtained results, the developed framework is computationally more efficient and more accurate with lowest rate of coefficient of variation (less than 5 %) that indicates the highest clinical significance of this research in the assessment of ATFL injuries.

Manipulative and Multimodal Therapies in the Treatment of Osteoarthritis of the Great Toe: A Case Series

OBJECTIVE

The objective of this case series is to describe manual manipulative therapy with exercise for 3 patients with mild to moderate osteoarthritis of the great toe.

CLINICAL FEATURES

Three patients, a 32-year-old man, a 55-year-old woman, and a 49-year-old woman, had great toe pain of 8, 1, and 2 years, respectively. Each had a palpable exostosis, a benign outgrowth of bone projecting outward from the bone surface, and decreased dorsiflexion with a hard end-feel.

INTERVENTION AND OUTCOME

Manual manipulative therapy with exercise, the Brantingham protocol, was used with patients receiving 6, 9, and 12 treatments over 6 weeks. Specific outcome measures for hallux rigidus and the foot were chosen to document the effects of this intervention including digital inclinometry, the lower extremity functional scale, the foot functional index, overall therapy effectiveness and Visual Analogue Scale (VAS). Each patient had an increase in range of motion that surpassed the minimal clinically important change, an increase in the overall therapy effectiveness and a decrease in the foot functional index that surpassed the minimally clinically important difference. Most importantly for the patients, each reported a decrease in both usual and worst pain on the VAS that exceeded the minimally clinically important difference of 20 to 30 mm.

CONCLUSION

The 3 patients reported decreased pain measured by the VAS, increased range of motion and minimally clinically important difference in 3 other outcome measures.

Application of plantography examination to the assessment of foot deformity in patients with rheumatoid arthritis

INTRODUCTION

Rheumatoid arthritis (RA) is a chronic, inflammatory and multiple-system disorder of connective tissue. It frequently affects joints and periarticular structures of feet that constitute a significant supporting element underlying normal gait and motion of the body centre of gravity. The aim of the study was to evaluate foot deformities on the basis of plantography examination in RA patients according to the severity of the disease.

MATERIAL AND METHODS

The study was performed on 54 RA patients. The control group consisted of 34 volunteers free of any disorders. Plantography examination was carried out by means of a CQ ST2K podoscope. The following parameters were applied to the assessment of the disturbances of foot statics: hallux valgus angle (α), Sztriter-Godunow index (KY), Wejsflog's index (Wwp) and Clarke's angle (CL).

RESULTS

Markedly higher values of the α angle were noted in RA patients, reflecting the presence of hallux valgus. Moreover, values of the α angle were higher in patients in the third stage of radiological changes than those in the second one. On the other hand, values of Clarke's angle for the right foot were significantly higher in men in the second and third stage of RA compared to the control group. The most common deformities in RA patients include HV and transverse flat foot, more explicit in women in the third stage of RA.

CONCLUSIONS

Plantography examination has been shown to constitute a useful diagnostic tool for assessment and monitoring of foot deformities in RA patients.

Asymptomatic Versus Symptomatic Ankle Joints in Rheumatoid Arthritis: A High-Resolution B-Mode and Power Doppler Ultrasound Study

OBJECTIVE

Ankle joints are frequently neglected in activity scoring systems, including the Disease Activity Score in 28 joints (DAS28). Only a few studies have assessed pathologies detected by ultrasonography of the ankles in symptomatic rheumatoid arthritis (RA) patients. We evaluated ankle joints in RA patients regardless of symptomatology, using musculoskeletal ultrasound (MSUS) as well as power Doppler ultrasound (PDUS).

METHODS

A total of 160 ankle joints of 80 RA patients were examined using MSUS and PDUS, according to the European League Against Rheumatism MSUS guidelines. Additionally, the talonavicular joints (TNJs) and the medial and the lateral tendon compartments were examined. The visual analog scale (VAS) score was recorded for each patient.

RESULTS

A total of 80 RA patients with a median age of 60 years and disease duration of 5 years were enrolled in our study. The median DAS28 score was 5. A total of 97 ankles were painful (VAS 1-10), whereas 63 ankles were asymptomatic (VAS 0). Overall, the predominant pathology was arthritis of the tibiotalar joint (TTJ) and/or TNJ in 124 ankles (77%), followed by tenosynovitis of the medial compartment tendons in 44 ankles (28%). Arthritis of the TTJ was present in 59% and synovitis of the TNJ in 35% of the symptomatic ankles. In asymptomatic ankles, TTJ synovitis was detected in 35%, whereas TNJ arthritis was observed in 18%. PDUS activity was higher in the subgroup of symptomatic ankles.

CONCLUSION

The most frequent pathologies detected by MSUS were arthritis of the TTJ and TNJ, followed by tenosynovitis of the medial compartment tendons. Pathologic findings were more frequent in symptomatic but also common in asymptomatic patients, whereas PDUS activity was generally low and mainly observed in symptomatic patients.

Associations of Region-Specific Foot Pain and Foot Biomechanics: The Framingham Foot Study

BACKGROUND

Specific regions of the foot are responsible for the gait tasks of weight acceptance, single-limb support, and forward propulsion. With region foot pain, gait abnormalities may arise and affect the plantar pressure and force pattern utilized. Therefore, this study's purpose was to evaluate plantar pressure and force pattern differences between adults with and without region-specific foot pain.

METHODS

Plantar pressure and force data were collected on Framingham Foot Study members while walking barefoot at a self-selected pace. Foot pain was evaluated by self-report and grouped by foot region (toe, forefoot, midfoot, or rearfoot) or regions (two or three or more regions) of pain. Unadjusted and adjusted linear regression with generalized estimating equations was used to determine associations between feet with and without foot pain.

RESULTS

Individuals with distal foot (forefoot or toes) pain had similar maximum vertical forces under the pain region, while those with proximal foot (rearfoot or midfoot) pain had different maximum vertical forces compared to those without regional foot pain (referent). During walking, there were significant differences in plantar loading and propulsion ranging from 2% to 4% between those with and without regional foot pain. Significant differences in normalized maximum vertical force and plantar pressure ranged from 5.3% to 12.4% and 3.4% to 24.1%, respectively, between those with and without regional foot pain.

CONCLUSIONS

Associations of regional foot pain with plantar pressure and force were different by regions of pain. Region-specific foot pain was not uniformly associated with an increase or decrease in loading and pressure patterns regions of pain.

Dynamic techniques for clinical assessment of the athlete

Clinical diagnostic tests objectively evaluate lower extremity ailments of the athlete. The positive squeeze test is found to be reproducible for ankle syndesmotic injury but is a poor prognosticator. The anterior drawer and talar tilt tests assess lateral ankle sprains. These have limitations secondary to positioning and guarding by the athlete, so comparison with the asymptomatic extremity is recommended. The Ottawa ankle rules assess possible fractures of the ankle and midfoot. The Thompson test evaluates Achilles tendon tears, whereas the windlass technique and the modified Lachman test examine the integrity of the plantar fascia and metatarsophalangeal joint capsule.

The tarsal bone test: a basic test of health sciences students' knowledge of lower limb anatomy

Objectives. The aim of the present study was to design an easy-to-use tool, the tarsal bone test (TBT), to provide a snapshot of podiatry students' basic anatomical knowledge of the bones of the lower limb. Methods. The study included 254 podiatry students from three different universities, 145 of them were first-year students and 109 were in their fourth and final years. The TBT was administered without prior notice to the participants and was to be completed in 5 minutes. Results. The results show that 97.2% of the subjects (n = 247) correctly labelled all tarsal bones, while the other 2.8% (n = 7) incorrectly labelled at least one bone, that was either the cuboid (7 times) or the navicular (6 times). Although only one fourth-year student inaccurately identified one bone, no significant differences in the distribution of the correct and incorrect responses were found between first and fourth-year students. Conclusions. The TBT seems to be a straightforward and easy-to-apply instrument, and provides an objective view of the level of knowledge acquired at different stages of podiatry studies.

Influence of pressure-relief insoles developed for loaded gait (backpackers and obese people) on plantar pressure distribution and ground reaction forces

The aims of this study were to test the effects of two pressure relief insoles developed for backpackers and obese people on the ground reaction forces (GRF) and plantar pressure peaks during gait; and to compare the GRF and plantar pressures among normal-weight, backpackers, and obese participants. Based on GRF, plantar pressures, and finite element analysis two insoles were manufactured: flat cork-based insole with (i) corkgel in the rearfoot and forefoot (SLS1) and with (ii) poron foam in the great toe and lateral forefoot (SLS2). Gait data were recorded from 21 normal-weight/backpackers and 10 obese participants. The SLS1 did not influence the GRF, but it relieved the pressure peaks for both backpackers and obese participants. In SLS2 the load acceptance GRF peak was lower; however, it did not reduce the plantar pressure peaks. The GRF and plantar pressure gait pattern were different among the normal-weight, backpackers and obese participants.

Associations of foot posture and function to lower extremity pain: results from a population-based foot study

OBJECTIVE

Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults.

METHODS

Participants were members of the Framingham Foot Study. Lower extremity joint pain was determined by the response to the National Health and Nutrition Examination Survey-type question, "On most days do you have pain, aching or stiffness in your (hips, knees, ankles, or feet)?" The Modified Arch Index classified participants as having planus, rectus (referent), or cavus foot posture. The Center of Pressure Excursion Index classified participants as having overpronated, normal (referent), or oversupinated foot function. Crude and adjusted (age, sex, and body mass index) logistic regression determined associations of foot posture and function to lower extremity pain.

RESULTS

Participants with planus structure had higher odds of knee (odds ratio [OR] 1.57, 95% confidence interval [95% CI] 1.24-1.99) or ankle (OR 1.47, 95% CI 1.05-2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (OR 7.56, 95% CI 1.99-28.8) and pain at 1 lower extremity site (OR 1.37, 95% CI 1.04-1.80). Associations between foot function and lower extremity joint pain were not statistically significant except for a reduced risk of hip pain in those with an oversupinated foot function (OR 0.69, 95% CI 0.51-0.93).

CONCLUSION

These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies.